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INTRODUCTION

Shockingly, it was recently reported that for the very first time in all of human history, the number of obese individuals in the world exceeds the number of those who are underweight. Large segments of our population are at high risk for a multitude of serious maladies, perinatal morbidity and mortality, and ultimately, premature death. Despite the widely described negative health consequences of obesity, the obesity epidemic continues to challenge clinicians, researchers, public health policy makers, and the healthcare system. The problem is not solely limited to the developed world, as obesity has become a World Health Organization focus as it relates to global health improvement initiatives. Globally, more than 1 billion people are overweight with more than 300 million being obese. Cancer, orthopedic complications, diabetes, hypertension, stroke, heart disease, premature death, and other serious complications (Table 6-1) have been well described, and yet the public health goal of the populace achieving a normal body mass index (BMI) has been elusive. Sadly, obesity is a well-recognized “common denominator” to preventable mortality, and obese (as well as overweight) adults have been shown to be at significantly higher risks for any-cause mortality, than their leaner counterparts. The unfortunate trend toward a sedentary lifestyle and unhealthful eating habits has likely contributed to this unfortunate and costly situation, although unquestionably, myriad psycho-socio economic, genetic, and environmental factors are likely contributory. Ironically, despite the decades-long availability of dietetic, fat-free, low-fat, sugar-free, and low-calorie foods and beverages, not to mention the ubiquitous presence of health clubs in our communities, there are more obese Americans today than at any previous time in our history. In the CDC’s most recent analysis (2015), it was found that more than 72 million American adults are obese, which constitutes more than 36% of the adult population, and accounts for a staggering $150 billion of annual obesity-related healthcare expenditures. In just the 2 years between 2007 and 2009, 2.4 million more adult Americans became obese! While obesity is now recognized in 12.5 million American children and adolescents (17% of this population), sadly, nearly 1/3rd of all children ages 2 to 19 years are now either overweight or obese. Relevant to the practitioner of obstetrics, the prevalence of obesity is higher in women (38.3%) than in men (34.3%). Despite some differences in obesity prevalence based upon levels of education, income, and ethnicity/race, it is clear that over the past decades, obesity rates have increased for both men and women of all socioeconomic strata. While the number of obese Americans stood at just 13% in 1962, presently, approximately two in three US women are either overweight or obese, with the highest prevalence of 57% noted among non-Hispanic Black women aged 20 and over. Colorado remains the “leanest” state, with just 18% of its population obese, while the “heaviest” state is Mississippi, with nearly 35% of its adult population obese. At least nine states have obesity rates of at least 30%, as compared to none ...